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Introduction <p>Interleukin-17 inhibitors (IL-17i) represent a key therapeutic option for psoriatic arthritis (PsA), but real-world evidence regarding the effectiveness of cycling strategies within this class is lacking. This study evaluated the real-world retention of IL-17i in PsA, focusing on whether prior IL-17i exposure affects subsequent IL-17i persistence.</p> Methods <p>This multicentre, retrospective, observational study included consecutive patients with PsA treated with an IL-17i across 24 Italian rheumatology centres. The primary outcome was drug retention, analysed using Kaplan–Meier methods, with differences between IL-17i-naïve and IL-17i-experienced patients assessed with the log-rank test. Secondary outcomes included baseline clinical characteristics and predictors of discontinuation.</p> Results <p>A total of 868 patients were included (59.3% female, 40.7% male; median age 56 [48–63] years; 89.3% IL-17i-naïve). The overall median IL-17i retention rate was 90.7% [95%&#xa0;CI 88.7–92.8] at 6&#xa0;months, 77.5% [95%&#xa0;CI 74.6–80.6] at 12&#xa0;months, 60.9% [95%&#xa0;CI 57.3–64.8] at 24&#xa0;months, and 52.1% [95%&#xa0;CI 48.1–56.4] at 36&#xa0;months. Among IL-17i-naïve patients, retention rates were 90.5%, 77.6%, 61.7%, and 53.9% at 6, 12, 24, and 36&#xa0;months, respectively. Among IL-17i-experienced patients, the corresponding retention rates were 92.2%, 77.0%, 54.0%, and 33.9%. In multivariable Cox regression, male sex and prior IL-17 inhibitor exposure were associated with a lower risk of discontinuation, whereas axial involvement, a higher number of previous biologic/targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs), and later calendar year of IL-17i initiation predicted poorer retention.</p> Conclusions <p>IL-17i showed high long-term retention in real-world PsA, with no significant difference between naïve and previously exposed patients. These findings support the sustained effectiveness of IL-17i therapy and suggest that cycling within the class may remain a reasonable option for selected cases.</p>

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Does Prior Exposure Affect Retention? A Real-World, Multicentre Assessment of IL-17 Inhibitor Cycling in Psoriatic Arthritis

  • 期刊论文

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  • 发表日期：

    2026年3月14日

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  • Valentino Paci,
  • Alarico Ariani,
  • Eleonora Celletti,
  • Olga Addimanda,
  • Alberto Lo Gullo,
  • Camilla Mazzanti,
  • Myriam Di Penta,
  • Emanuela Sabatini,
  • Francesco Cipollone,
  • Gianluca Santoboni,
  • Claudio Angrisani,
  • Massimiliano De Simone,
  • Valeria Nucera,
  • Aurora Ianniello,
  • Giulia Vallifuoco,
  • Natalia Mansueto,
  • Romina Andracco,
  • Giulio Ferrero,
  • Rosalba Caccavale,
  • Marino Paroli,
  • Patrizia Del Medico,
  • Gianluca Smerilli,
  • Antonella Farina,
  • Palma Scolieri,
  • Vincenzo Bruzzese,
  • Cecilia Giampietro,
  • Francesca Ometto,
  • Gentiana Vukatana,
  • Marica Trevisani,
  • Rita Mulè,
  • Elisa Rossi,
  • Enrica Vandelli,
  • Riccardo Bixio,
  • Alessandro Volpe,
  • Antonio Marchetta,
  • Maddalena Larosa,
  • Dario Camellino,
  • Gerolamo Bianchi,
  • Viviana Ravagnani,
  • Federica Lumetti,
  • Aldo Biagio Molica Colella,
  • Veronica Franchina,
  • Francesco Molica Colella,
  • Elena Bravi,
  • Ilaria Platè,
  • Eugenio Arrigoni,
  • Rosetta Vitetta,
  • Francesca Serale,
  • Alessia Fiorenza,
  • Davide Murgia,
  • Guido Rovera,
  • Gabriele Amati,
  • Elisa Visalli,
  • Giorgio Amato,
  • Francesco De Lucia,
  • Ylenia Dal Bosco,
  • Roberta Foti,
  • Enrico Fusaro,
  • Maria Chiara Ditto,
  • Simone Bernardi,
  • Francesco Girelli,
  • Marta Priora,
  • Alessandra Bezzi,
  • Maria Cristina Focherini,
  • Fabio Mascella,
  • Andrea Becciolini,
  • Eleonora Di Donato,
  • Giuditta Adorni,
  • Gianluca Lucchini,
  • Daniele Santilli,
  • Beatrice Gabrielli,
  • Dilia Giuggioli,
  • Bernd Raffeiner,
  • Massimo Reta,
  • Mirco Magnani,
  • Luca Idolazzi,
  • Gilda Sandri,
  • Rosario Foti,
  • Simone Parisi,
  • Michele Maria Luchetti Gentiloni,
  • Gianluca Moroncini

摘要

Introduction

Interleukin-17 inhibitors (IL-17i) represent a key therapeutic option for psoriatic arthritis (PsA), but real-world evidence regarding the effectiveness of cycling strategies within this class is lacking. This study evaluated the real-world retention of IL-17i in PsA, focusing on whether prior IL-17i exposure affects subsequent IL-17i persistence.

Methods

This multicentre, retrospective, observational study included consecutive patients with PsA treated with an IL-17i across 24 Italian rheumatology centres. The primary outcome was drug retention, analysed using Kaplan–Meier methods, with differences between IL-17i-naïve and IL-17i-experienced patients assessed with the log-rank test. Secondary outcomes included baseline clinical characteristics and predictors of discontinuation.

Results

A total of 868 patients were included (59.3% female, 40.7% male; median age 56 [48–63] years; 89.3% IL-17i-naïve). The overall median IL-17i retention rate was 90.7% [95% CI 88.7–92.8] at 6 months, 77.5% [95% CI 74.6–80.6] at 12 months, 60.9% [95% CI 57.3–64.8] at 24 months, and 52.1% [95% CI 48.1–56.4] at 36 months. Among IL-17i-naïve patients, retention rates were 90.5%, 77.6%, 61.7%, and 53.9% at 6, 12, 24, and 36 months, respectively. Among IL-17i-experienced patients, the corresponding retention rates were 92.2%, 77.0%, 54.0%, and 33.9%. In multivariable Cox regression, male sex and prior IL-17 inhibitor exposure were associated with a lower risk of discontinuation, whereas axial involvement, a higher number of previous biologic/targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs), and later calendar year of IL-17i initiation predicted poorer retention.

Conclusions

IL-17i showed high long-term retention in real-world PsA, with no significant difference between naïve and previously exposed patients. These findings support the sustained effectiveness of IL-17i therapy and suggest that cycling within the class may remain a reasonable option for selected cases.